When Religion and Medicine Clash: Non-beneficial Treatments and Hope for a Miracle

Abstract

Patient and family demands for the initiation or continuation of life-sustaining medically non-beneficial treatments continues to be a major issue. This is especially relevant in intensive care units, but is also a challenge in other settings, most notably with cardiopulmonary resuscitation. Differences of opinion between physicians and patients/families about what are appropriate interventions in specific clinical situations are often fraught with highly strained emotions, and perhaps none more so when the family bases their desires on religious belief. In this essay, I discuss non-beneficial treatments in light of these sorts of disputes, when there is a clash between the nominally secular world of fact- and evidence-based medicine and the faith-based world of hope for a miraculous cure. I ask the question whether religious belief can justify providing treatment that has either no or a vanishly small chance of restoring meaningful function. I conclude that non-beneficial therapy by its very definition cannot be helpful, and indeed is often harmful, to patients and hence cannot be justified no matter what the source or kind of reasons used to support its use. Therefore, doctors may legitimately refuse to provide such treatments, so long as they do so for acceptable clinical reasons. They must also offer alternatives, including second (and third) opinions, as well the option of transferring the care of the patient to a more accommodating physician or institution.

Preventing moral conflicts in patient care: Insights from a mixed-methods study with clinical experts

“…58 Differing values and worldviews, whether religious, cultural or moral, are well-documented causes of MPs. 59 As moral values and worldviews are usually resistant to immediate change, preventive measures may focus on recognising disagreements early on, supporting moral tolerance and establishing procedures and standards to balance interests.…”

Continuation of Hemodialysis in a Patient With Global Hypoxic Brain Injury

“…13 In these situations, consistent communication from the medical team is important to stress that a treatment may be nonbeneficial and actually result in harm. 13 If the family is unable to accept the prognosis and recommendations provided by the medical team, then efforts should be made to offer alternatives, including a second opinion and transition of care to another provider. 13 Compliance with HD was a factor that was suspected to have contributed to the patient's OHCA.…”

“…13 If the family is unable to accept the prognosis and recommendations provided by the medical team, then efforts should be made to offer alternatives, including a second opinion and transition of care to another provider. 13 Compliance with HD was a factor that was suspected to have contributed to the patient's OHCA. Although adherence to HD in the Latino population has not been studied extensively, a small study explored perceptions of Mexican Americans regarding their treatments to determine how this may impact adherence.…”

Physicians at the crossroad of prognosis and faith: practical help communicating with patients and families during the COVID-19 pandemic

“…Thirdly, communicate without any declarative or dismissive statements. In situations where a patient’s family is desperate for a ‘miracle’ and repetitively states their belief in the same and the pragmatic physician in you knows this is not going to happen, it is acceptable to ‘leave the door open’, letting the family know that you are open to reassessing the situation and adapt management decisions depending on the patient’s clinical course, even as we embrace palliative measures and comfort care in the meantime [ 12 ]. It is a useful tool to emphasize that the decision is ‘what the patient would have wanted’ rather than what we/family desires for the patient, which puts the weight of the decision on the patient rather than the caregiver.…”